Insurance with $20,000 Deductible?!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

lol, this. The person who started this thread is stupid. You don't look at an out of network deductible for a plan like this. Duh.

You are the stupid one. (I can't believe the way people who don't understand the shortcomings of Obamacare throw insults around.) The problem is there are real failings with Obamacare. They have limited in-network providers, and customers are not really fully insured because THEY DO NOT HAVE ALL SPECIALISTS IN NETWORK. It makes it appear that as long as you stay in-network, you'll be fine, but you don't always have that option.

Oh really? Please list the specialties that are not in network. We'll wait.

[Anonymous]

Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

The point is that they are saying they are a PPO with out-of-network benefits, but the deductible is so sky-high that you're "encouraged" to stay in-network. The problem comes about when they don't have a specialist and you are forced out of network.

I think we're still waiting for OP to come back and show us where it says they don't have anyone in-network in a particular specialty. Even if it's the case, though, typically PPOs will have an appeals process by which you may be able to get coverage for out-of-network providers at the in-network rate if they truly have no specialists available in-network that could treat the insured.

I'm the OP and I am back. No....it doesn't say on that form that they are missing specialists. But I know from experience that many plans - including this one - do. Congress knows as well, as there have been numerous complaints from exchange customers that the specialist they need is not in network. It actually pretty commonplace, and a REAL problem, but Obama is burying it. Still trying to hide how much damage he's done.
http://khn.org/morning-breakout/in-network-access-to-specialists-not-always-available-on-some-obamacare-plans-study-finds/

[Anonymous]

There may be some sort of appeal for that situation. Hard to imagine that Inova wouldn't have most kinds of specialists in its network. It's a pretty large system.

Now, I wouldn't be thrilled about having to stay within the Inova system either, but it's just more like an HMO and its a high quality system at least.

I posted before, but, again, there's nothing unique about this being "Obamacare." If you work for Inova I think this is the plan you have available as an employer sponsored plan.

So, yes, you might not like the plans available for purchase but they are not necessarily all that different than what many employers offer these days.

[Anonymous]

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

Well....do a search on a specialty, and there will be (admittedly rare) instances where it comes up saying, "no in-network specialist."

[Anonymous]

I worked at Duke University for 3 years while my husband attended law school there. During that time, we were on a "duke only" health insurance plan. Premiums and copays were super low, but ALL visits had to be with Duke affiliated doctors. Non-Duke coverage (which also had very low copays) was limited to emergency care only. There was literally ZERO reimbursement for out of network care that was not considered an emergency.

The care we received and the doctors we saw were excellent. It did not feel limiting in any way, and there were specialists in every field. Even IVF was completely covered. I would love access to a plan like this here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What's the in network deductible?

I thought the point of PPO plans was you had to stay in network. Our PPO has a really high out if network deductible as well. We have to pay cash for our child's psychiatrist and psychologist, neither of whom take insurance at all.

+1. Complaining that a PPO has poor out-of-network benefits is like complaining that you have pay out of pocket if you go outside your network on an HMO. It reflects a fundamental misunderstanding of insurance programs that has nothing to do with Obamacare.

The point is that they are saying they are a PPO with out-of-network benefits, but the deductible is so sky-high that you're "encouraged" to stay in-network. The problem comes about when they don't have a specialist and you are forced out of network.

I think we're still waiting for OP to come back and show us where it says they don't have anyone in-network in a particular specialty. Even if it's the case, though, typically PPOs will have an appeals process by which you may be able to get coverage for out-of-network providers at the in-network rate if they truly have no specialists available in-network that could treat the insured.

I'm the OP and I am back. No....it doesn't say on that form that they are missing specialists. But I know from experience that many plans - including this one - do. Congress knows as well, as there have been numerous complaints from exchange customers that the specialist they need is not in network. It actually pretty commonplace, and a REAL problem, but Obama is burying it. Still trying to hide how much damage he's done.
http://khn.org/morning-breakout/in-network-access-to-specialists-not-always-available-on-some-obamacare-plans-study-finds/

Oh. I hate when I think we're having a substantive conversation when facts and then... Not so much.

[Anonymous]

Do people just need to be educated on how ppo and Hmo plans work? A specialist you need will be in network, you might not have your choice amongst doctors but there will be one. Or you appeal and get an exception.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The whole point of that plan is to leverage Inova's local presence for maximum benefit. You don't buy that kind of plan to go out of network. It's like being mad that your car can't cross a lake.

lol, this. The person who started this thread is stupid. You don't look at an out of network deductible for a plan like this. Duh.

You are the stupid one. (I can't believe the way people who don't understand the shortcomings of Obamacare throw insults around.) The problem is there are real failings with Obamacare. They have limited in-network providers, and customers are not really fully insured because THEY DO NOT HAVE ALL SPECIALISTS IN NETWORK. It makes it appear that as long as you stay in-network, you'll be fine, but you don't always have that option.

Yes, there are real failings with Obamacare, but I'm on board with Hillary's plan to improve it.

[Anonymous]

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

I just looked up child & adolescent psychiatry in the Innovation network OP has been talking about, and found 28 in-network providers within 25 miles of me in northern Virginia, several less than five miles away. You may not find the provider you would ideally like to use in-network, but if you need to stay in-network, you have options.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

Well....do a search on a specialty, and there will be (admittedly rare) instances where it comes up saying, "no in-network specialist."

Please provide us with an example of this, because so far I haven't found any specialties without providers in the Innovation network.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

I just looked up child & adolescent psychiatry in the Innovation network OP has been talking about, and found 28 in-network providers within 25 miles of me in northern Virginia, several less than five miles away. You may not find the provider you would ideally like to use in-network, but if you need to stay in-network, you have options.

That far exceeds an employer-provided plan I once had that only had four psychiatrists in all of Maryland.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

Well....do a search on a specialty, and there will be (admittedly rare) instances where it comes up saying, "no in-network specialist."

Please provide us with an example of this, because so far I haven't found any specialties without providers in the Innovation network.

OP here. I will work on it. As I said, it's uncommon, but it does occur. I'll get back with an example.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

I just looked up child & adolescent psychiatry in the Innovation network OP has been talking about, and found 28 in-network providers within 25 miles of me in northern Virginia, several less than five miles away. You may not find the provider you would ideally like to use in-network, but if you need to stay in-network, you have options.

We have a bcbs ppo and have never been able to find child psychs in network who are taking new patients in northern va. Do you mind posting a link so I can look at it? I'm just really curious.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Some specialists---like child psychiatrists-- don't take insurance at all, as pp noted.

But Inova is a big system, I'm curious about the specialists who aren't in network. Because they sell this to their employees as more like an hmo and one of the selling points is how varied the network is.

I just looked up child & adolescent psychiatry in the Innovation network OP has been talking about, and found 28 in-network providers within 25 miles of me in northern Virginia, several less than five miles away. You may not find the provider you would ideally like to use in-network, but if you need to stay in-network, you have options.

We have a bcbs ppo and have never been able to find child psychs in network who are taking new patients in northern va. Do you mind posting a link so I can look at it? I'm just really curious.

See if this link works for you so you can tailor the search to your zip code: https://my.innovation-health.com/#/provider-search/plan-selection. I searched the 2017 Bronze plan.